Local hospitals largely fare well in new federal data

Saturday

Dec 22, 2012 at 12:01 AMDec 22, 2012 at 12:14 AM

The federal government released new data this week that base nearly $1 billion in Medicare payments to U.S. hospitals next year on their performance, and the news was mostly good for central Ohio's hospitals. The data show how much hospitals stand to gain or lose - as much as 1 percent in Medicare reimbursement - based on how well they followed 12 clinical standards of care and scored on certain patient-satisfaction criteria. A Kaiser Health News review of the data found that the gain or loss at nearly two-thirds of hospitals should be less than 0.25 percent of their regular Medicare payments, which exclude money for capital improvements, resident education and caring for the poor.

Ben Sutherly, The Columbus Dispatch

The federal government released new data this week that base nearly $1 billion in Medicare payments to U.S. hospitals next year on their performance, and the news was mostly good for central Ohio’s hospitals.

The data show how much hospitals stand to gain or lose — as much as 1 percent in Medicare reimbursement — based on how well they followed 12 clinical standards of care and scored on certain patient-satisfaction criteria.

A Kaiser Health News review of the data found that the gain or loss at nearly two-thirds of hospitals should be less than 0.25 percent of their regular Medicare payments, which exclude money for capital improvements, resident education and caring for the poor.

The public release of the data comes four months after the government announced the size of penalties for hospitals that readmitted too many patients just weeks after discharge.

Those readmission penalties also can be as much as 1 percent of a hospital’s Medicare reimbursement. That means that, theoretically, as much as 2 percent of a hospital’s Medicare revenue now hinges on how well it performs.

The changes are part of the federal health-care overhaul.

In many cases, local hospitals scored well enough on clinical care standards and patient-satisfaction criteria — dubbed “value-based purchasing” by the government — to offset their losses from readmission penalties.

OhioHealth, for example, will receive about $400,000 in additional Medicare reimbursement through value-based purchasing. That’s more than enough to offset about $300,000 that the hospital system stands to lose through the readmission-rate penalty, according to Steve Umland, OhioHealth’s senior vice president of finance.

Ohio State University’s Wexner Medical Center will recoup some of the $700,000 it expects to lose annually under the readmission penalty, and will end up with a net loss of about $500,000.

Mount Carmel Health System declined to say how much money it stands to gain or lose under value-based purchasing. In August, the health system said it expected to lose about $400,000 from the readmission penalty.

Among the dozen clinical standards of care used to calculate the value-based purchasing data: whether a patient was given instructions before leaving the hospital; how well the hospital controls heart patients’ blood sugar after surgery; and whether beta blockers were given to lower the blood pressure of surgery patients.

Local hospitals say they have taken several steps in recent years to bolster their performance.

OhioHealth, for example, is expanding a practice it began a year ago at Riverside Methodist Hospital to the entire hospital system, said Dr. Amy Imm, OhioHealth’s vice president of quality and patient safety. The practice, which didn’t go over well with some health-care workers at first, involves pausing briefly when the apparent victim of a severe heart attack arrives at the hospital to assess whether the patient should undergo a catheterization.

The delay has not added a significant amount of time to treatment, Imm said. She said that in the first three months, it helped hospital officials identify more than 10 patients who appeared to have suffered a heart attack but in fact had not.

OSU’s Wexner Medical Center has worked to make sure that clinical care standards are “ hard-wired” into hospital processes, said Dr. Edmund Funai, the hospital system’s chief operating officer. Health-care workers now use “safe surgical checklists” in the operating room, and they are working to keep as quiet as possible around patients at night.

Eighty people in leadership positions at Wexner Medical Center are spending a significant amount of their time working toward that goal, he said.

To improve patient satisfaction, Mount Carmel has made changes such as consistently checking on patients every hour and following up with them through phone calls after they leave the hospital, Mount Carmel spokesman Jason Koma said.

The federal government gradually will increase the amount of reimbursement that hinges on hospital readmissions, quality of care and patient satisfaction, and that could begin to eat into slim surpluses at some hospitals, particularly smaller ones, Imm said.

“The program improves quality, but it could be on the backs of some hospitals that just simply can’t survive those big penalties” in the future, Imm said.

Information from Kaiser Health News was used in this story.

bsutherly@dispatch.com

@BenSutherly

Never miss a story

Choose the plan that's right for you.
Digital access or digital and print delivery.